3B2-20043-44560

2 vaccinations 15 coded responses 25 check-ins 15 free-text entries 6 call cases

Sex: —
Age at first dose: 31-35
ZIP prefix: 984 / WA
Registered: 2021-03-31

Relationship: Self
Race: White
Ethnicity: Not Hispanic or Latino

Timeline

Registration Vaccinations Survey responses Call reports Cases without a report Call attempts Call successful Pregnancy survey

2021-03-31
Registered in v-safe
2021-03-31
Dose 1 — Moderna
2021-03-31
Health check-in — day 0, dose 1
Feeling: Fair · Headache, Muscle or body aches, Fatigue or tiredness, Abdominal pain

Adult check-in
2021-04-01
Survey response — days 1–6 daily, dose 1
MedDRA: Ear pain — Feeling: Poor · Site: Pain · Muscle or body aches, Fatigue or tiredness, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Transient ear pain

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Insomnia, Nasal dryness — Feeling: Poor · Site: Pain, Swelling · Fever · Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Reddness in my left nostril, dry feeling. Visual optical illusion disturbances related to digital screens flowing like a curtain or drifting. Underwater feeling. Increased talking and agitation. Trouble sleeping.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-02
Report sent to call center — days 1–6 daily, dose 1
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-03
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness, Rash, Visual impairment — Feeling: Fair · Site: Pain · Fatigue or tiredness, Diarrhea, Rash, not including the immediate area around the injection site

Free text: Rash in left nostril, Wooziness, Vision Blurring upon waking, Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-04
Survey response — days 1–6 daily, dose 1
MedDRA: Erythema, Nasal mucosal disorder, Sneezing, Vision blurred — Feeling: Fair · Be unable to do your normal daily activities

Free text: Increased Vision Blurring, Sneezing, Red inside left nostril

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-05
Survey response — days 1–6 daily, dose 1
MedDRA: Vision blurred — Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Vision blurring when turning head too quickly

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-06
Survey response — days 1–6 daily, dose 1
MedDRA: Dizziness — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-07
Survey response — day 7, dose 1
MedDRA: Dizziness — Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Free text: Wooziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Survey response — day 14, dose 1
MedDRA: Dizziness — Feeling: Poor · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Wooziness, dizziness

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-14
Report sent to call center — day 14, dose 1
Get care from a doctor or other healthcare professional

1 call case(s)
2021-04-21
Health check-in — day 21, dose 1
Feeling: Fair

Adult check-in
2021-04-28
Dose 2 — Moderna
2021-04-28
Survey response — day 0, dose 2
MedDRA: Dizziness, Vision blurred — Feeling: Fair · Site: Pain, Swelling · Headache, Muscle or body aches · Be unable to do your normal daily activities

Free text: Dizziness, Blurry Vision

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-29
Survey response — days 1–6 daily, dose 2
MedDRA: Vision blurred — Feeling: Poor · Site: Pain · Fever · Chills, Headache, Muscle or body aches, Fatigue or tiredness, Nausea, Abdominal pain · Be unable to work, Be unable to do your normal daily activities

Free text: Vision Blurring

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-04-30
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Site: Pain · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-02
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-03
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-04
Health check-in — days 1–6 daily, dose 2
Feeling: Fair · Muscle or body aches, Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-08
Health check-in — day 7, dose 2
Feeling: Fair · Fatigue or tiredness · Be unable to do your normal daily activities

Adult check-in
2021-05-12
Health check-in — day 14, dose 2
Feeling: Fair

Adult check-in
2021-05-21
Health check-in — day 21, dose 2
Feeling: Fair

Adult check-in
2021-05-26
Survey response — day 28, dose 2
MedDRA: Headache, Pain in extremity, Paraesthesia — Feeling: Fair · Be unable to do your normal daily activities

Free text: Tingling in feet, aches in legs, headache

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Survey response — day 35, dose 2
MedDRA: Agitation, Depression — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Agitation increased, depression increased

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-02
Report sent to call center — day 35, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-09
Survey response — day 42, dose 2
MedDRA: Agitation, Depression, Injection site pain — Feeling: Fair · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Sporadic deep pain in arm at injection site. Agitation, depression.

MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
2021-06-09
Report sent to call center — day 42, dose 2
Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional

1 call case(s)
2021-06-15
Call 1 — Left Voicemail
2021-06-15
Call 1 — Left Voicemail
2021-06-15
Call 1 — Left Voicemail
2021-06-15
Call 1 — Left Voicemail
2021-07-28
Health check-in — 3 months, dose 2
Feeling: Fair

Adult check-in
2021-11-01
Survey response — 6 months, dose 2
MedDRA: Hypoaesthesia, Hypoaesthesia oral, Intranasal hypoaesthesia, Unevaluable event — Feeling: Fair · Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Symptoms: Facial, gum, and nostril numbness on right side of my face · Healthcare visit (other): Was recommended to seek Outpatient services for an MRI but hesitant due to COVID risk

MedDRA releases: 2024-11 · check-in free text available
2021-11-01
Report sent to call center — 6 months, dose 2
Get care from a doctor or other healthcare professional

Telehealth, virtual health, or email health consultation · 1 call case(s)
2021-11-03
Call 1 — Left Voicemail
2022-04-28
Survey response — 12 months, dose 2
MedDRA: Diplopia, Eye patch application, Vision blurred — Feeling: Fair · Be unable to work or attend school, Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Telehealth, virtual health, or email health consultation

Free text: Right eye seemed to have issues focusing. Got double vision requiring an eyepatch beginning ~3/14 and seemed to dissipate starting 4/8

MedDRA releases: 2024-11 · check-in free text available
2022-04-28
Report sent to call center — 12 months, dose 2
Be unable to work or attend school · Be unable to do your normal daily activities · Get care from a doctor or other healthcare pr

Telehealth, virtual health, or email health consultation · 1 call case(s)
2022-05-02
Call 1 — Left Voicemail

Vaccinations

Dose	Date	Manufacturer	Co-administered
1	2021-03-31	Moderna
2	2021-04-28	Moderna

Call center

6 call center cases

6 unsuccessful

See the call center timeline

Free text

Release 6 — days 1–6 daily, dose 1

2021-04-01

Systemic reaction (other): Transient ear pain

2021-04-02

Systemic reaction (other): Reddness in my left nostril, dry feeling. Visual optical illusion disturbances related to digital screens flowing like a curtain or drifting. Underwater feeling. Increased talking and agitation. Trouble sleeping.

2021-04-03

Systemic reaction (other): Rash in left nostril, Wooziness, Vision Blurring upon waking, Dizziness

2021-04-04

Systemic reaction (other): Increased Vision Blurring, Sneezing, Red inside left nostril

2021-04-05

Systemic reaction (other): Vision blurring when turning head too quickly

Release 7 — days 1–6 daily, dose 1

2021-04-06

Systemic reaction (other): Dizziness

Release 7 — day 7, dose 1

2021-04-07

Systemic reaction (other): Wooziness

Release 7 — day 14, dose 1

2021-04-14

Symptoms: Wooziness, dizziness

Release 8 — day 0, dose 2

2021-04-28

Systemic reaction (other): Dizziness, Blurry Vision

Release 8 — days 1–6 daily, dose 2

2021-04-29

Systemic reaction (other): Vision Blurring

Release 8 — day 28, dose 2

2021-05-26

Symptoms: Tingling in feet, aches in legs, headache

Release 8 — day 35, dose 2

2021-06-02

Symptoms: Agitation increased, depression increased

Release 9 — day 42, dose 2

2021-06-09

Symptoms: Sporadic deep pain in arm at injection site. Agitation, depression.

Release 10 — 6 months, dose 2

2021-11-01

Symptoms: Facial, gum, and nostril numbness on right side of my face

Healthcare visit (other): Was recommended to seek Outpatient services for an MRI but hesitant due to COVID risk

Release 11 — 12 months, dose 2

2022-04-28

Symptoms: Right eye seemed to have issues focusing. Got double vision requiring an eyepatch beginning ~3/14 and seemed to dissipate starting 4/8

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

Field	Preferred term	2021-09	2023-04	2024-11
HCVO	Unevaluable event	·	·	✓
SD	Agitation	✓	✓	✓
SD	Depression	✓	✓	✓
SD	Diplopia	·	·	✓
SD	Dizziness	✓	✓	✓
SD	Eye patch application	·	·	✓
SD	Headache	✓	✓	✓
SD	Hypoaesthesia	·	·	✓
SD	Hypoaesthesia oral	·	·	✓
SD	Injection site pain	✓	✓	✓
SD	Intranasal hypoaesthesia	·	·	✓
SD	Pain in extremity	✓	✓	✓
SD	Paraesthesia	✓	✓	✓
SD	Vision blurred	·	·	✓
SRO	Dizziness	✓	✓	✓
SRO	Ear pain	✓	✓	✓
SRO	Erythema	✓	✓	✓
SRO	Insomnia	✓	✓	✓
SRO	Nasal dryness	✓	✓	✓
SRO	Nasal mucosal disorder	○	✓	✓
SRO	Rash	✓	✓	✓
SRO	Sneezing	✓	✓	✓
SRO	Vision blurred	✓	✓	✓
SRO	Visual impairment	✓	✓	✓

✓ active code · ○ coded but marked inactive · blank = not in that release